Gestational diabetes mellitus is defined as abnormalities in glucose tolerance of varying degrees first detected or occurring during pregnancy. The recent effects of gestational diabetes on the mother and child have been widely recognized, such as the risk of gestational hypertension, preeclampsia, excessive amniotic fluid, miscarriage, preterm delivery, intrauterine death, fetal malformation, macrosomia, neonatal asphyxia, intrauterine fetal infection, neonatal hyperbilirubinemia, and increased cesarean section rate due to large fetuses. At present, the long-term effects of gestational diabetes on mother and child are receiving more and more attention, as described below.
I. Long-term effects of gestational diabetes on the mother.
Risk of recurrence in another pregnancy.
Studies have found that the recurrence rate of recurrence of gestational diabetes in pregnant women ranges from 30% to 84%, and the recurrence rate varies between races. The risk of recurrence has been associated with the following factors: excess weight before pregnancy, gestational diabetes diagnosed before 24 weeks of pregnancy, weight gain of more than 7 kg during pregnancy, need for insulin therapy, and less than 2 years between pregnancies.
Gestational diabetes mellitus and type II diabetes mellitus.
Patients with gestational diabetes are significantly more likely to develop type II diabetes after delivery than women without a history of gestational diabetes.
The risk factors for the subsequent development of type II diabetes in this group of pregnant women are.
(i) High fasting glucose during pregnancy.
(ii) Glucose tolerance test (OGTT) at 2h glucose level ≥ 11.7 mmol/L, multiple abnormal OGTT values, excessive weight during pregnancy, and gestational diabetes diagnosed before 24 weeks of gestation.
(iii) Those with more than 2 pregnancies.
④1h postprandial glucose greater than 10.1mmol/L.
(⑤) requiring insulin therapy during pregnancy.
⑥positive for antibodies against islet cells and glutamic acid decarboxylase.
(vii) Asian ancestry.
Gestational diabetes mellitus and postpartum metabolic syndrome.
Studies have found a significantly increased risk of future metabolic syndrome in gestational diabetes. The metabolic syndrome includes cardiovascular disease, hypertension, dyslipidemia, and type II diabetes mellitus, even at a younger age.
Association of gestational diabetes with postpartum breast and pancreatic cancer.
It was found that the more severe the abnormalities of glucose metabolism during pregnancy in pregnant women with gestational diabetes, the greater the possibility of their future malignancies, especially in the breast and pancreas.
Visceral obesity: the possibility of visceral obesity in pregnant women with gestational diabetes is significantly higher than that of normal women.
II. Long-term effects of gestational diabetes on the offspring.
The incidence of abnormal glucose tolerance and diabetes mellitus is significantly higher in the offspring of gestational diabetes.
Pregnant women with gestational diabetes usually lead to hyperinsulinemia in newborns, and future offspring are more likely to develop diabetes, and female offspring of childbearing age may also develop gestational diabetes.
Association between gestational diabetes and offspring obesity.
All growth indicators in newborns of mothers with gestational diabetes are higher than in newborns of mothers without diabetes; the higher the maternal glucose screening value, the greater the risk of obesity in their offspring; obese parents and overweight offspring at birth are both associated with obesity in offspring.
Abnormalities of the cardiovascular system in the offspring of gestational diabetes.
Pregnant women with gestational diabetes have a significantly increased risk of future cardiovascular disease in their offspring.
Offspring metabolic syndrome.
The incidence of metabolic syndrome is significantly increased in the offspring of pregnant women with gestational diabetes mellitus.
Abnormalities in neuromotor development.
Pregnant women with gestational diabetes have a high incidence of psychiatric and motor developmental disorders in their offspring. The effects on the offspring also include decreased language function, social skills, and oculomotor function. These abnormalities may be related to the varying effects of gestational diabetes on the neurological development of the offspring; to abnormal intrauterine development, neonatal hypoglycemia, increased birth injuries and even the effects of medication.
In summary, in view of the aforementioned long-term effects of gestational diabetes on the mother and child, early glucose screening should be performed in pregnant women with high-risk factors so that such women can be promptly diagnosed and treated and their blood glucose can be controlled in the normal range as early as possible. Postpartum guidance on healthy lifestyles for mothers and children can delay or prevent the occurrence of various long-term adverse prognoses for mothers and children in the future.